Doctor Q&A: Can vitamin E supplements increase my risk of cancer? Doctor Renée answers your burning health questions

Hi Dr Renée, what is the best way to put type 2 diabetes into remission?

Type 2 diabetes happens when your body no longer responds well to insulin or doesn’t produce enough insulin for your needs. Insulin is a hormone produced by the pancreas that normally results in sugar that we eat and produce being stored in the cells of the body. When the process isn’t working so well, blood sugar (glucose) levels rise and this causes diabetes. Diabetes is a disease of high blood sugar that causes damage to all body organs, nerves and tissues, increases the risk of infection and hinders normal healing.

The biggest cause of type 2 diabetes is obesity and hence the most recognised method of putting it into remission (return of normal blood sugar readings) is weight loss. However, it isn’t as simple as that as some non-obese people develop diabetes. Furthermore, people who have certain weight loss surgeries which alter the hormones of the stomach and/or gut microbiome seem to go into remission before losing significant weight.

Having said that, a kickstart low-calorie diet of 800-1000 calories for 12 weeks has been proven to induce remission and the DIRECT1 study showed that almost a quarter of the trial participants who started with the low-calorie approach were still in remission at 5 years with an average 8.9kg weight loss.

There are three factors that potentially predict remission successes: weight loss, baseline pancreatic function and diabetes duration. So essentially the more weight you lose, the shorter the time being diabetic and how well your pancreas still works will dictate your chances of remission. So early diagnosis and then action is key.

But what else can you do? Michael Mosley, who became pre-diabetic and was not overweight, has some brilliant books on this. In essence, he showed that the key pillars for losing body fat include adhering to a healthy diet of non-processed food such as vegetables and fresh produce, and for some, he says going slowly along this route may be better and more sustainable. He also promoted intermittent fasting and restricted eating windows which we know have long-term health benefits. And of course, exercise as part of that, not just for weight loss, but for physical and heart health. Fast exercise, or High intensity interval training (HIIT) was also a Mosley mainstay. You can find a summary of his ideas here.

If I leave you with one message from all of this, it's that all of the above are good for you whether you have diabetes or just want to look and feel better all round and live a long healthy life.

Vitamin E is a collective name for a group of vitamins found in oily foods. It helps maintain a healthy immune system, healthy vision and skin. It is a fat-stored vitamin so you don’t lose any that you don’t use and as a result, you only need to consume a small amount in your diet to maintain sufficient levels and deficiency is uncommon. Taking a vitamin E supplement can cause high levels to be stored in the body and this can be harmful.

Vitamin E is an anti-oxidant so can help repair cell damage, protect you against environmental stressors such as radiation and help maintain your immune system and promote healthy vision and skin.

There is some conflicting research on the pros and cons of vitamin E supplementation. For example, some research suggests vitamin E can delay the progression of Alzheimer’s in those with an early diagnosis but others failed to show this. Some research showed improvement in symptoms in non-alcoholic fatty liver disease but research also showed that two years of supplementation also increased insulin resistance and therefore the risk of diabetes!

In answer to your question re cancer, research shows that vitamin E and selenium supplements don't prevent prostate cancer and that the use of vitamin E supplements might increase the risk of prostate cancer. In another trial of patients with head and neck cancers, those who received vitamin E had a higher rate of second primary cancers compared with placebo. There are also concerns that high levels of vitamin E may interfere with radiation treatment.

Vitamin E is easy to get in a balanced diet. Good sources include:

· Plant oils, but I would stick with Olive oil

· Nuts and seeds, particularly almonds with half a cup having all you need

· Wheatgerm oil – just a tablespoon is more than needed a day.

I think my summary would be: yes it’s an essential oil for health, but you always have to be careful with fat-stored vitamins and as this one is easy to get from a good diet, I would stick to that and not take a supplement. There are some potentially dangerous side effects so eat some nuts and know you are doing it the right way.

Hi Dr Renée, what's the best exercise for easing lower back pain?

This is a fun question for me because my other half is a spinal surgeon so there is a lot of back discussion in our house!

The answer is really straightforward and includes core stability, strength and maintaining mobility.

As a GP I see a patient for back pain in every single surgery. It is common and it is debilitating. I always try and stress the following:

1. Most low back pain will resolve within six to eight weeks

2. If you have low back pain it will wax and wane and you will have flares of severe pain.

3. The worst thing to do in a flare is take to your bed - gentle mobilisation is key.

4. Core strengthening between flares will help support the problem area and minimise the flares or even solve it.

The easiest and most efficient exercise for core strengthening isn’t fancy yoga or Pilates but planks. Just do planks religiously and whilst initially, you will likely struggle at 10 seconds, after a short time you will be able to read the newspaper whilst holding a plank.

Here's a great plank video.

There are of course other exercises to do, including stretches aimed at low back mobility and I found a good programme here.

But if none of this is working for you, this YouTube site channel written by a spinal surgeon I know and has playlists of home exercises designed to help you fix your issue from the neck to low back.

If nothing is helping, then longer term more invasive treatments include steroid injections and depending on what the cause is, potentially surgery. But as my other half says, surgery should always be the very last resort. I hope this helps!